Research indicates that nurses currently spend less than half their time delivering direct patient care. Time and motion studies show that the majority of nurses’ time is spent walking between the patient rooms, the nursing unit core, or in the nursing station. In the report Keeping Patients Safe, the Institute of Medicine (IOM) states that estimates from work sampling studies and surveys of nurses within individual hospitals demonstrate that the amount of time spent in patient care documentation ranges from 13 to 28 percent.
Wasted time, energy, and material are pervasive in health care. Medical-surgical units can learn and adapt valuable lessons from “lean” organizations
such as Toyota, which is steeped in a culture that continuously encourages employees to identify value and non-value-added activities from the customer’s perspective.
 Hendrich A, Lee N. A Time and Motion Study of Health Care Workers: Tribes of Hunters and Gatherers. Unpublished data cited in the IOM report, Keeping Patients Safe.
 Institute of Medicine Committee on the Work Environment for Nurses and Patient Safety. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press; 2003.
IHI has developed a How-to Guide containing measures, changes, and tools that focus on value-added care processes.